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Abstract

Introduction: Unintentional paediatric poisoning remains a major public health issue worldwide. Practice of cord care varies in various places; in Nigeria methylated spirit is commonly used but no report from poisoning following its use. There is no available poisoning data from Gusau, North Western Nigeria, we report a day old neonate accidentally given methylated spirit assumed to be medication whom was managed in our hospital. Case report: Baby I.J is a-day-old male term neonate who presented with 3 hours history of ingestion of methylated spirit and 2 hours history of difficulty in breathing. He was accidentally given a bottle cap full of methylated spirit by a care giver thought to be medication in a hospital. He was managed with oxygen and antibiotics. Conclusion: Accidental ingestion of methylated spirit is uncommon, even though methylated spirit is a common household agent used for cord care and cleaning minor wounds. Caution should be taken when taking care of newborns, high index of suspicion is required when considering neonatal poisoning. Medications should not be given to newborns by any care giver unless assigned by the mother or given by health personnel.

Keywords

Methylated spirit; Neonate; Poisoning

Introduction

Unintentional paediatric poisoning remains a major public
health issue worldwide. [1] In developed countries, poisonings
have no or limited clinical effects, rather it puts substantial
burden on health care systems. [1] Practice of cord care varies in
various places from using alcohol, methylated spirit, povidone
iodine or chlorhexidine to clean the cord, in Nigeria methylated
spirit is commonly used.

Methylated spirits is a common household product which is
readily available at a range of retail outlets like chemists and
pharmacies. It is composed of 70–99% ethanol, water and
denatonium benzoate. [2] Denatonium benzoate is added to make
it have an intensely bitter taste so as to reduce the amount of
liquid likely to be consumed accidentally. [2]

Methylated spirits is not classified as acutely toxic, but ingestion
of small quantities can cause serious health effects due to the high
ethanol concentration. [2] There is no data available on the acute
toxicity of the product sold as methylated spirits. [2] Accidental
poisoning in children have been reported from different centres
in Nigeria but few have reported on poisoning in neonates. [3,4]

There is no available poisoning data from Gusau, North
Western Nigeria, we report a day old neonate accidentally given
methylated spirit assumed to be medication whom was managed
in our hospital. This is a rare presentation of poisoning in a newborn and this case highlights the need to have a high index
of suspicion with regards to poisoning in any child irrespective
of the age.

Case Report

Baby I.J is a-day-old male term neonate who presented to
our hospital with 3 hours history of ingestion of methylated
spirit and 2 hours history of difficulty in breathing. He was
accidentally given a bottle cap full of methylated spirit by a
care giver thought to be medication in the referral hospital. He
was subsequently breast fed and vomited 2 times, though there
was denial of induced vomiting. He later developed difficulty
in breathing and cough, but no associated bluish discolouration
nor fever.

Pregnancy was unsupervised and he was delivered at a
peripheral hospital via emergency caesarean section on account
of prolonged obstructed labour to a grand multiparous woman
(Para 11). Birth weight was 2.7 kilograms.

On examination, he was acutely ill looking, afebrile and not cyanosed. He was tachypnoiec with respiratory rate of 90 cycles/
min and dyspnoeic. He had secretions from the nose and mouth.
There was decreased air entry with crepitations in both lung
fields. Oxygen saturation in room air was 90%. Heart rate was
160 beats per minute, regular and heart sounds were normal.

A diagnosis of aspiration pneumonitis secondary to methylated
spirit ingestion was made. Secretions were suctioned and he
was placed on intranasal oxygen at 2 litres/minute, intravenous
antibiotics (Ampiclox with Gentamicin) and maintenance
intravenous fluid (10% dextrose at 60 ml/kg body weight over
24 hours at 7 drops/minute). Full blood count and differentials;
chest x-ray; urea, electrolytes and creatinine were requested.
Electrocardiogram is not done in neonates in our hospital
due to lack of appropriate leads, hence not requested. The
investigations were not done as the father did not pay at all.

Eleven hours after admission, he developed fever and oxygen
saturation dropped to 84%. He was still dyspnoeic and
tachypnoiec, oxygen therapy was continued. After 24 hours of
admission, oxygen saturation on oxygen was 99% and 90% in
room air, baby remained stable.

The father requested for discharge against medical advice after
48 hours of admission despite counselling; because the baby
was better and perceived he no longer required oxygen. Baby
was discharged on syrup Ampiclox, however on follow up
phone call he was found to be well after discharge.

Discussion and Conclusion

Poisoning in neonates is not common which makes data of
accidental or non-accidental poisoning in neonates to be few.
[3-5] Poisoning from methylated spirit is also uncommon, data are
also few in children. [2,6]

Even though methylated spirit is used for cord care in neonates,
the mother of our index case knows the use, a care giver
assumed it was meant for ingestion and without consulting the
mother gave the baby. Aspiration is not common with a little
volume, but there is the possibility of induced vomiting after
breastfeeding the baby which could have resulted in aspiration
and led to the cough and difficulty in breathing in our index
case.

There is no available data on aspiration of methylated spirit in
neonates to the best of our knowledge; hence the need to present
this unusual case so that it can be a warning to put on alert for
similar situations.

Data from the New Zealand Poisons Call Centre ranks
methylated spirits between 6th and 12th annual most common
cause of calls over the period 2008–2012. [2] The majority of
calls across all age groups relate to ingestion of methylated
spirits. Smaller numbers of calls relate to eye, skin and inhalation
exposures. Approximately 40% of calls relate to 0–3 year olds
being exposed to methylated spirits during exploratory play. [2]

Ethanol is rapidly absorbed from the gastrointestinal tract into the blood stream providing systemic exposure to the chemical.
[2] Acute systemic exposure to ethanol and its metabolites can
result in behavioural and motor coordination changes at low level
blood alcohol concentrations. Higher levels of blood alcohol
lead to depression of the respiratory system, with the possibility
of coma and death. [2] Other symptoms of acute alcohol intake
include memory loss, nausea and vomiting. Aspiration of vomit
by drowsy or unconscious people who have consumed ethanol
can also lead to death. [2]

Young children are at higher risk of poisoning from the ethanol
in methylated spirit due to their small body size compared to the
amount of product they may have consumed. [2] Children under
five years may also have limitation in the metabolism of the
ethanol due to their immature hepatic ethanol dehydrogenase
activity. [7]

In New Zealand, of the 123 incidents of methylated spirit
poisoning involving children under four years of age, 119 were
due to exploratory play and 4 due to unintentional exposures.
[2] Hospital admissions data in New Zealand between 2006 to
2012 showed there have been 73 hospital events associated with
methylated spirits. However, none occurred in children under
the age of 15years. [2]

Accidental poisoning in neonates is uncommon; a six hour old
baby was reported in Zaria by Abdulkadir et al. [3] who presented
with shortness of breath and haematemesis five hours after
accidental ingestion of sulfuric acid.

A three day old neonate was reported from Kano [4] with
clinical features initially thought to be due to neonatal seizures
and sepsis, but later found to be due to non-accidental dettol
poisoning by a single mother.

In another report from Kano by Belonwu et al. [6] on childhood
poisoning, two children both 3 years of age ingested methylated
spirit and they both presented with cough and difficulty in
breathing. In Burkina Faso, [5] 1.3% of their admissions were
from poisoning which included a 6 day old neonate, though
cause of poisoning was not stated. Many studies on childhood
poisoning reported on poisoning in children beyond infancy
period but none reported poisoning with methylated spirit. [8-13]

We followed up the baby by phone call and he was found to be in
stable condition since discharge. This report recommends proper
storage of poisonous chemicals and proper health education
of mothers and other care givers on dispensing medications.
There is also need for establishing poison control or toxicologic
screening centres in Nigeria with branches in all the 36 states
which will assist in the management of poisoning cases.

Baby IJ accidentally ingested methylated spirit in a hospital
which could have been prevented if medications were not
served by care givers. Accidental ingestion of methylated spirit
is uncommon, even though methylated spirit is a common
household agent used for cord care and cleaning minor wounds.
Caution should be taken when taking care of newborns, high index of suspicion is required when considering neonatal
poisoning. Medications should not be given to newborns by
any care giver unless assigned by the mother or given by health
personnel.